Heather A. Joseph, MPH,a Robin Shrestha-Kuwahara, MPH,a Diane Lowry, MPH, MSW,a Lauren A. Lambert, MPH,a
Adelisa L. Panlilio, MD, MPH,b Beth G. Raucher, MD, MSHCM,c James M. Holcombe, MPPA,d Jan Poujade, RN, MS,e
Diane M. Rasmussen, RN,f and Maureen Wilce, MSa
Atlanta, Georgia, New York, New York, Jackson, Mississippi, Portland, Oregon, and Kansas City, Missouri
Background: Despite the known risk of tuberculosis (TB) to health care workers (HCWs), research suggests that many are not fully
adherent with local TB infection control policies. The objective of this exploratory study was to identify factors influencing HCWs’
adherence to policies for routine tuberculin skin tests (TSTs) and treatment of latent TB infection (LTBI).
Methods: Sixteen focus groups were conducted with clinical and nonclinical staff at 2 hospitals and 2 health departments.
Participants were segmented by adherence to TST or LTBI treatment policies. In-depth, qualitative analysis was conducted to
identify facilitators and barriers to adherence.
Results: Among all focus groups, common themes included the perception that the TSTwas mandatory, the belief that conducting
TSTs at the work site facilitated adherence, and a general misunderstanding about TB epidemiology and pathogenesis. Adherent
groups more commonly mentioned facilitators, such as the perception that periodic tuberculin skin testing was protective and the
employee health (EH) provision of support services. Barriers, such as the logistic difficulty in obtaining the TST, the perception that
LTBI treatment was harmful, and a distrust of EH, emerged consistently in nonadherent groups.
Conclusions: This information may be used to develop more effective interventions for promoting HCW adherence to TB
prevention policies. Informed efforts can be implemented in coordination with reevaluations of infection control and EH programs
that may be prompted by the publication of the revised TB infection control guidelines issued by the Centers for Disease Control
and Prevention in 2005. (Am J Infect Control 2004;32:456-61.)
Factors influencing health care workers’ adherence to work site tuberculosis screening and treatment policies